OBJECTIVES: The purpose of this study was to define appropriate parameters for risk stratification and prognosis in patients undergoing stress echocardiography. BACKGROUND: Stress echocardiography is an established technique for the diagnosis of coronary artery disease. However, current data on risk stratification of patients undergoing stress echocardi ography are limited. METHODS: We evaluated 1,500 patients (59 ± 13 years old; 51% male) undergoing stress echocardiog raphy (34% with treadmill exercise and 66% with dobutamine). Resting left ventricular ejection fraction (EF) and regional wall motion were assessed by the consensus of two echocardiographers. Follow-up (mean 2.7 ± 1.0 years) for confirmed non-fatal myocardial infarction (n = 31) and cardiac death (n = 44) were performed. RESULTS: By univariate analysis, both the peak wall motion score index (WMSI) (p < 0.0001) and EF (p < 0.0001) were significant predictors of cardiac events. Peak WMSI effectively risk stratified patients into low (0.9%/year), intermediate (3.1%/year), and high (5.2%/year) risk groups (p < 0.0001). A threshold of 45% EF provided further risk stratification of all WMSI groups. By multivariate logistic regression analysis, peak WMSI (relative risk [RR] 2.1, 95% confidence interval [CI] 1.0 to 4.4; p = 0.04) and EF (RR 1.0, 95% CI 0.9 to 1.0; p = 0.01) were both predictors of cardiac events. CONCLUSIONS: Stress echocardiography yields prognostic information for risk stratification of patients with known or suspected ischemic heart disease. A normal stress echocardiographic study (peak WMSI = 1.0) confers a benign prognosis (0.9%/year cardiac event rate). Peak WMSI >1.7 and EF ≤45% are independent markers of patients at high risk of an adverse clinical outcome. © 2003 by the American College of Cardiology Foundation.
Yao, S. S., Qureshi, E., Sherrid, M. V., & Chaudhry, F. A. (2003). Practical applications in stress echocardiography: Risk stratification and prognosis in patients with known or suspected ischemic heart disease. Journal of the American College of Cardiology, 42(6), 1084–1090. https://doi.org/10.1016/S0735-1097(03)00923-9